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Summary of health and well-being key issues for the people of Kirklees Joint Strategic Needs Assessment for Kirklees

2009

Summary of issues for the people of Kirklees 1

The summary of the JSNA 2009 priorities for the health and well-being of Kirklees people These priorities remain similar to the previous JSNA 2008, in having the main impact on local people. These priorities include topics, specific groups of people and localities most in need. For some needs, the picture has improved, but sadly many have not.

Specific vulnerable groups

Wider factors

Women of child bearing age: their personal behaviours

Isolation and social networks

People with disabilities

Employment and income

Older people

Educational attainment and skills

Conditions Heart disease and stroke Emotional well-being Pain Obesity Diabetes Dementia

Personal behaviours Smoking Food and nutrition Physical activity Alcohol Sexual health for children and young people

2 NHS Kirklees and Kirklees Council

Housing affordability and adequacy A lot of energy is going into tackling these already.

There is still much to do: • In linking actions more coherently to have greater impact for people.

• In narrowing the avoidable gaps in health and wellbeing experienced by Kirklees people.

• The national recession is already affecting local people and will increase stress, thus how people cope and so affect many of the above issues.

Looking to the longer term future there are two very significant threats to local health and well-being: • What we eat and how active we are. Both have widespread impact across the rainbow for individuals in Kirklees, and have worsened.

• They also have a major impact on climate change, which will affect all of us collectively and individually.

Summary of priorities for the health and well-being of local children and young people Summary

Physical inactivity

The main challenges facing children and young people continue to be:

Although levels of physical activity seem to be increasing, there are still more than 1 in 3 children and young people not doing enough to benefit their health.

Teenage girls, overweight and obese children and those living on low incomes are the least likely to be active.

Dying before their first birthday (infant deaths) This remains an important problem for Kirklees – the infant death rates locally are the second highest in Yorkshire and the Humber and amongst the highest in England. There is a 3 fold variation across localities, and 4 localities had a rate of more than 8 deaths per 1,000 live births.

Personal unhappiness and social isolation* This remains an important issue in Kirklees as in the last JSNA. Young people in poor relationships are more likely to have low self esteem which results in them being unable to resist peer pressure. This can impact of smoking, use of alcohol, drugs, sexual activity, lack of confidence in building relationships and doing poorly at school.

Obesity More than 1 in 5 children in reception class were overweight or obese and this rose to 1 in 3 by the time they reached Year 6, and the proportion who are obese is increasing. This is catastrophic for future health both locally and nationally.

The key issues affecting the main challenges above were: Emotional well-being Poor relationships, low self esteem, poor self image and worry affects significant numbers of children and young people across Kirklees, and this affects their emotional and psychological well-being and ability to cope.

Educational attainment

Smoking tobacco* Smoking rates are still too high with 1 in 8 smoking weekly. Nearly half of children and young people are exposed to tobacco smoke at home and even before birth with 1 in 5 of non-South Asian women smoking at birth.

Drug misuse Nationally drug use amongst all age groups has started to decline. However local estimates still show that amongst vulnerable young people over 1,000 are likely to have a substance misuse problem.

Alcohol use* Alcohol use affects much larger numbers of young people than other drugs, and alcohol abuse has continued to rise sharply in 14 year olds.

Teenage pregnancies and sexual health Having children at an early age can damage young women’s health and well-being and severely limit their education and life chances. The local rate has reduced since 1998 but is still significantly higher than the regional and national average. Empowering young people to be aware of choice in relation to sexual health and developing the skills and confidence to delay sexual activity is crucial.

The health

behaviours of women of child bearing age, i.e. under 45 years have a pivotal role

in shaping family behaviours, and so infant death and obesity. See section on women of child bearing age.

Levels of educational attainment continue to rise.

However there is a complex pattern of inequalities between different ethnic groups, different communities and different schools.

Disabilities* are a priority as so little local data is reliably available. The needs of children with disabilities are currently being assessed and will be reported in the next JSNA.

Food*

Safeguarding children

Poor diet leads to a range of health issues, most obviously obesity which is increasing locally. Decayed or missing teeth in 5 year olds is an indicator of poor diet and rates locally are almost double nationally and there is a 6 fold variation across localities.

More than 200 children across Kirklees have a child protection plan or are on the register. Safeguarding children and young people and promoting their welfare must be at the core of all services. A new child death review process has been established and findings from this will be reported in the next JSNA.

Summary of issues for the people of Kirklees 3

Health and well-being key issues of CHILDREN AND YOUNG PEOPLE in Kirklees This table summarises the relevant indicators for the key issues for children and young people. It shows the most recent data for Kirklees, including significant differences between boys and girls. Much of the data is from the Young People’s Survey 2007 (see section 10) and was used in the last JSNA. Therefore the table shows how the current data compares with either the previous Young People’s Survey 2005 or the data included in the last JSNA if it was from other sources. Comparison with the most recent national data is also shown where possible.

Indicators Infant deaths Average no. of decayed, missing, filled teeth, 5 yr olds Obese LAA NI 56 Being healthy aged 14 Physically active enough daily LAA local Doing less than 30 mins physical activity daily LAA local No breakfast before school Smoking weekly or more

Happy to continue smoking ♦ Drink alcohol weekly or more ♦

Out of control weekly or more ♦

Drink alone ♦ Using illegal drugs monthly or more LAA NI 115 Teenage pregnancies LAA NI 112 Had sexual intercourse

No contraception used Emotional well-being aged 14 LAA NI 50 Miserable Angry Lonely Poor relationships School staff

Family Unhappy at school Unhappy with self Do not have someone to talk to about problems Staying safe aged 14 Bullied

Past 2 months LAA NI 69 Worried weekly or more about it Enjoying and Achieving Achievement at Early Years Foundation Stage English and Maths at KS2 Males English and Maths at KS2 Females 5+ GCSEs A*-C [incl English and Maths] LAA NI 78

Males 5+ GCSEs A*-C [incl English and Maths] LAA NI 78

Females 5+ GCSEs A*-C [incl E & M] Pakistani origin LAA local Key: ♦ of those who smoked or drank

Kirklees

Worse

Vs 2005 / last JSNA  (0.76) = X

Vs nationally X (4.9) X (1.5) X

Girls 24 Girls 37

 (29) X (26) = = X (20) X (24) X (5) = =  (4.5) =  (19)

X (53)

0.70 2.3 19 33 30 22 13 26 48 8 15 4.4 4.3 17 16 23 34 12 36 19 35 26 22

Girls 16 Boys 29

Girls 18

Girls 29 Girls 17 Girls 26

=

 (5.0) X (4.1)

X (20) X (30) = = = X (33) = =

14 7

X (12) =

55 70 73 41

 (41)* = (70)* = (73)*  (36)

 (49) = X (75) X (43)

50

 (42)

X (52)

33

 (30)*

X (40)

For data on all these indicators at a locality level see section 6 or 7 of the full report. For definitions of indicators see section 11 of the full report.

 where better than 2005 or nationally = same as 2005 or nationally X where worse than 2005 or nationally * 2006 data

4 NHS Kirklees and Kirklees Council

* This has not been updated since the last JSNA.

Summary of locality health and well-being inequalities - children and young people

South Kirklees localities had higher levels of emotional distress and poor relationships.

Compared to elsewhere, North Kirklees localities had:

Overall Batley, Dewsbury and Huddersfield faced the greatest inequalities in issues that are changeable through local action.

• Higher levels of unhealthy behaviours.

• More poor households with children.

• Lower educational attainment especially 5 A*-C GCSEs in English and Mathematics.

Summary of locality health and well-being inequalities - CHILDREN AND YOUNG PEOPLE¨ ¨ Key issues

Bat

B&B

DDK

Dew

Mir

HN

HS

Spen

CV

HV

Infant deaths Average no. of decayed, missing, filled teeth, 5 yr olds 14 year olds Physically inactive

LAA local

Smoking weekly

♦

Happy to smoke

♦

Alcohol weekly

♦

Drink alone

♦

Using drugs

LAA NI 115

Teenage conceptions LAA NI 112 Had sex Felt miserable



LAA NI 50

Felt angry Poor relationships school staff Unhappy with self Do not have someone to talk to Bullied past 2 months LAA NI 169 Children in households claiming CTC and/or WTC Achievement at Early Years Foundation Stage English and Maths at KS2

Males

English and Maths at KS2 Females 5 GCSE’s A*-C incl English and Maths

LAA NI 78 Males

5 GCSE’s A*-C incl English and Maths

LAA NI 78 Females

Key: ♦ of those who smoked or drank Significantly worse than Kirklees average Significantly worse than Kirklees average and updated or new data 

Improved since last report and no longer significantly worse than Kirklees average

For data on all of these indicators see section 7 of the full report - indicator tables, for a full description see section 6 of the full report - localities.

For definition of indicators see section 11 of the full report.

NOTE: Valleys now shown separately Colne Valley, Holme Valley so some changes from previous report where one Valley particularly relevant for that issue

Italics indicate LAA

Summary of issues for the people of Kirklees 5

Summary of the priorities for the health and well-being of local adults This section gives: 1. A summary of the key needs across the rainbow of health and well-being, and their relationships to each other.

2. A table summarising the needs by locality.

3. A summary of the key issues including those most at risk (i.e. inequality).

4. A brief summary of all the issues which are described in full in section 5 of the full report.

To use this section, start with a topic or the population of interest, or locality.

For further detail on each topic or vulnerable group then go to the Adults section 5 of the full report, which also identifies those people most at risk and includes the Local Area Agreement information, where possible.

For geographical detail, go to the Localities section 6 of the full report.

The Indicator Tables section 7 of the full report gives all the data for each topic by locality, Kirklees overall and nationally where available.

Summary of the priorities and their relationships to each other Specific vulnerable groups Perhaps unsurprisingly some groups experience more challenges:

Young adults, aged 18 - 44 had poorer health behaviours (especially women) and were more likely to feel isolated, or feel people did not get on locally.

Women of child bearing age: more smoked at birth in localities with high infant deaths. More were also obese or overweight and as physically inactive as before. Their high levels of drinking alcohol remain unchanged.

LAA local

Older people were more likely to have poorer health functioning especially physical, pain, long term conditions and dementia. They were less likely to smoke or drink excessively, but were physically inactive. Yet they felt more positive about people locally getting on and belonging locally, than younger people.

LAA NI 137 Carers were also more likely to have poorer health functioning, especially physical and pain. They were less likely to be employed and more were disabled themselves. They did not feel isolated.

People with physical disability obviously have poorer health functioning (especially physical, role and social), pain, are more likely to smoke and be 6 NHS Kirklees and Kirklees Council

obese. They were far more likely to feel isolated, had lower income but lower levels of benefits and felt their housing was inadequate.

People with learning disabilities are more likely to live in the Huddersfield localities and Dewsbury & Mirfield. They are also much more likely to have a range of health issues and variable quality of healthcare.

More young adults with learning disabilities are from families of Pakistani origin.

For those with long term conditions such as cardiovascular disease, pain, diabetes, depression and / or anxiety LAA NI 124 They were highly likely to be completely physically inactive and have poorer health functioning especially physical and pain. Although less smoked than overall, this was still too high, given that virtually all of such conditions are worsened by smoking. For those with diabetes and obesity, more had unhealthy behaviours than in 2005.

More were overweight rather than obese, far more than in 2005.

They tended to be poorer and tended not to be in work.

Lung cancer was higher in younger women, worse than nationally, and is linked to smoking levels.

People with long term conditions were challenged by physical limitations and pain, but not so much emotionally. Given their weight has increased so much since 2005, perhaps they are coping through what they eat and too many still use smoking to cope. They are much less likely to misuse alcohol than the overall population.

Health behaviours

Social & community factors

Smoking: Reducing in people with long term conditions but still too high, as many of these conditions are linked to smoking. More young adults, especially women, and poorer people smoked; compounding their disadvantage.

LAA NI 123

Feeling isolated: More in young adults, those with

Alcohol: Excess alcohol drinking has plateaued in most groups but was far higher than nationally, especially for men. Young women had caught up with young men for excess drinking for the first time locally.

Alcohol significantly contributes to calorie intake, thus weight.

LAA local

Physical inactivity: Less than 1 in 3 were sufficiently active to benefit their health. More people with long term conditions or disability were physically inactive, as were those who felt isolated, this had worsened since 2005. People not in work or on low income were also physically inactive.

LAA NI 8 Food & Nutrition: No reliable local data, but is linked to much ill health and most notably obviously obesity and diabetes. Given the increase in weight locally and nationally, then perhaps as smoking has decreased more people are returning to food as a means of coping.

health problems i.e. having a disability or with poorer health especially pain, smoked, were physically inactive, had low income or no work.

Volunteering: Only 1 in 4 people volunteer regularly and those with health conditions are least likely to volunteer.

LAA NI 6 Getting on with each other locally: Young adults were least likely to agree, and were more concerned about anti-social behaviour as were those of Black and Minority Ethnic (BME) origin.

LAA NI 1,2,17,local

Wider factors Low income: Household incomes remained lower than nationally. Clearly linked to most issues across the rainbow.

Felt housing was inadequate: Linked strongly to disability i.e. older people, having a disability, having asthma or carers as well as of BME origin.

Unemployed: Those most likely to be unemployed are people with a disability or long term condition and carers. Unemployment is a major cause of social isolation.

Climate change: All of us are responsible and are, or will be, affected. As we have all become used to the petrol engine as a form of transport rather than legs, this reduction in physical activity is harming our individual health as well as the environment.

LAA NI 187, 188

Summary of issues for the people of Kirklees 7

8 NHS Kirklees and Kirklees Council

Dementia Communicable disease Asthma Smoking Physically inactive Alcohol over limit bingeing People do not get on with each other Concern about antisocial behaviour Isolation Housing inadequacy

Cancers

Diabetes

High BP Heart disease Stroke Depression / anxiety Pain Overweight/obese

Carers Offenders CVD:

Learning disability

Physical disability

People with:

18-24

18-24

18-24

18-24

18-44 18-44

Lung women

45-64

45-64

X  18-44 X

18-44 X

18-44 Hepatitis

SA

BME

Black / White SA, Black White White

TB Pakistani

-

-

Black obese

Sight SA Hearing White Pakistani 18-24 18-44 SA -

Ethnicity

Prostate Lung Bowel Lung

18-44



18-44

Women

Black & SA

 X

X

Over 65

Hearing Sight

Men

X

65-74



Aged under Aged over 65 65

Low

-

Low Low High

-

-

Breast high

Low Low Low Low Low Low Low under 65

Benefits low -

-

Income

-

-

-

-

-

No work

-

-

-

-

-

-

-

-

-

Housing Permanently sick inadequacy

Inequalities in health and well-being of ADULTS: age, gender, ethnicity and wider factors affecting health

The tables below present the needs affecting local health and well-being. It also identifies those most at risk for each issue, i.e. the related inequalities.

-

-

-

-

-

Isolation

Summary of issues for the people of Kirklees 9

X X



-

Overweight/Obese

Diabetes

Dementia Older

 significantly better than 2005

X significantly worse than 2005

- no data

relatively worse

Ethnic origin: SA South Asian

Key:

* Excludes cancer and food / nutrition as local data is unavailable.

Isolation

Asthma

X

Pain excl. backache

-

X

Depression, anxiety

-

-

Physically inactive

X

-

-

Smoking

CVD incl. stroke

Offenders

Carers

Learning disability

Physical disability

People with:

-

-

Alcohol

Over 65

-

Obese X

X

Overweight X

-

Obese

Overweight/ Obese

-

X

-

Physical health function

-



Illness incl.

Dementia

Mental health function

People with conditions or vulnerability and their significant personal behaviours or health functioning *

-

-

-

Pain

-



Avoidable death

Summary of locality health and well-being inequalities - ADULTS Being healthy Life expectancy at birth Males Life expectancy at birth Females Role Functioning Cancer new cases of Breast Heart disease aged under 65 years Heart, stroke deaths aged under 75 years High blood pressure Stroke Asthma Diabetes Pain problems Depression, anxiety or other nervous illness Obesity Either obese or overweight Cancer deaths aged under 75 years Deaths all causes aged 15-64 years Personal behaviours Smoking LAA NI 123 Alcohol over sensible limits ♦ Males Alcohol over sensible limits ♦ Females LAA NI local Enough physical activity

LAA NI 8 local Women of childbearing age Smoking daily LAA local Smoking at birth of child (excl. S. Asian pop) LAA local Over sensible limit of alcohol last week ♦ Bingeing alcohol last week ♦

LAA local Enough physical activity Obese or overweight Living and working Low Income Feel lonely/isolated all or most of time Home not adequate for needs

Bat

B&B

DDK

Dew

Mirf

HN

HS

Spen

CV

HV



 

  





  



 





Key:

Remains worse than Kirklees, i.e. unchanged since JSNA 2008

♦ of those who drank alcohol

Deteriorated since JSNA 2008

Italics are LAA topics



Improved since last report and no longer significantly worse than Kirklees average

For data on all of these indicators see section 7 of the full report - indicator tables, for a full description see section 6 of the full report - localities.

For definition of indicators see section 11 of the full report.

NOTE: Valleys now shown separately Colne Valley, Holme Valley so some changes from previous report where one Valley particularly relevant for that issue

10 NHS Kirklees and Kirklees Council

Dewsbury continues to have the worst health picture in Kirklees. Even where Dewsbury is no longer worse, this is because other areas have worsened and Dewsbury is static.

Batley and Huddersfield have deteriorated since 2005, as has Mirfield.

Denby Dale & Kirkburton and the Valleys continue to experience the best health.

Summary of each issue for adults, identifying inequalities i.e. those most at risk The focus for this edition of the JSNA has been updating the information about the health and well-being of adults. This is because of the wealth of new data available from the 2008 CLIK survey.

This section summarises each issue, to give an overview of the whole picture. Further detail is in section 5 of the full report where each issue is described in full.

Population Population changes by 2025 • Estimated to grow by 7.4%.

• 15% increase in those aged under 19 mainly due to higher birth rate in South Asian population.

• 34% increase in those aged 65 – 84.

Women of child bearing age • More smoking at birth, and overall in this group, in localities with high infant deaths.

LAA local • Late booking for ante-natal care so lost opportunities for support.

LAA NI 126 • High levels of overweight/obesity and increasing.

• Low levels of physical activity.

LAA NI 8 • High levels of drinking over sensible limits but not increasing.

LAA local • High levels of bingeing on alcohol but the steep rise since 2001 has stopped.

LAA local • Pressures of time, cost and family/significant others affected unhealthy behaviours.

Adults physical disability and sensory impairment

• 63% increase in those aged over 85 but will be less than 5,000 people.

• 1 in 5 adults needed help or support with some form of physical functioning in getting around inside or outside the home, or help with daily living tasks.

Life expectancy and health status

• Pain was the most common condition affecting 2 in 3 of people needing such support.

Life expectancy • Improving at all ages due to the continued reduction of deaths in those aged under 75 from major killers – heart disease and cancers.

• Women will still live 3 years longer than men, at birth, but the gap is narrowing. This is emphasised by women in 2 localities and Kirklees wide, having significantly shorter lives than nationally, whereas this is true only for men in Dewsbury.

• Significant gap between localities with Holme Valley best for men and women and Dewsbury worst for men (5.1 years gap) and Batley worst for women (4.1 years gap).

Health status • Worse locally than nationally.

• Some aspects worse than 2005 including pain in those aged over 65, and mental health in all ages.

• Those with long term conditions or disability had worse health status except for those with asthma.

• Their physical, role and social functioning, as well as pain, were very affected. So not surprisingly were 6 times more likely to feel isolated all / most of the time than overall.

• Far more felt their home was inadequate for their needs.

• More likely to smoke and be obese than overall.

• Far less were employed. So they were poorer yet seemed to have low level of benefits.

• Far more were permanently sick.

• Sensory impairment: increased with age, more men, more visual impairment in South Asian (possibly due to diabetes), more than half have another disability, more had low income.

Learning disability • Mild, moderate and severe levels estimated to affect about 10,000 people in Kirklees. Of whom, 10% are severe and known to Council Adult Services and receive a service.

• Dewsbury has worst scores for all aspects and all ages.

• Concentrated in 4 localities: Huddersfield North and South, Dewsbury & Mirfield, Batley, Birstall & Birkenshaw.

• Batley low scores for those aged over 65, Huddersfield South low scores for those aged under 65.

• Higher rate of Pakistani origin in young adult learning disabled population.

So in summary, life expectancy is improving, especially for men, but gaps remain. Death rates are improving – but morbidity is not.

• Local increase in such disability has been 2 – 3% per year, but the changing ethnic profile could mean this will increase.

Summary of issues for the people of Kirklees 11

• Experience of health services and health outcomes for people with learning disabilities seem poor e.g.

- 4 times more likely to die of preventable causes

• Projections for 2025 show 50% increase in care home places required if model of care stays the same.

- more likely to be obese and have poor dental health especially those with Down’s Syndrome

• 1 in 7 older people were carers and most look after another older person.

- more likely to have mental health issues especially dementia and sight/hearing problems

Offender health

- appear to be less likely to have specific medical conditions adequately diagnosed and treated, e.g. heart disease, hypothyroidism and osteoporosis.

Carers • 1 in 8 adults i.e. 40,000 unpaid carers in Kirklees.

• Half were men, more than nationally, especially aged over 65.

• High levels of anxiety about caring, and poorer health functioning especially in male carers (as tended to be older).

• Less than 1 in 3 of those aged under 65 were employed.

• No more isolated than the overall population.

• Only 1 in 8 claimed Carers Allowance, so are they not providing enough care to be entitled or is it too difficult to apply?

• Age of person cared for linked to their vulnerability:

• More than 2 out of 3 offenders suffered from 2 or more mental health problems.

• Risk of dying in the first week after release is nearly 40 times higher than the general population, and often drugs related.

• 2 in 3 prisoners treated for mental health problems also had substance misuse problems.

• 2 out of 3 women offenders had substance misuse problems.

• 1 in 10 offenders being supervised in the community or in custody are women, and they are less likely to access health or health screening services, and half have children under 16.

• Children of offenders are 3 times more likely to experience mental health problems.

Heart disease, stroke and high blood pressure (CVD) LAA NI 124

- mental ill health and substance misuse – middle age

• Similar to nationally, is the most common cause of death including those aged under 75, so impacts on local life expectancy. Local death rates reducing and will achieve the 2010 target early.

- frailty and mental disorders – older people.

• Heart attacks, increasing.

- learning disability – young people

• 1 in 3 felt housing was inadequate, vs. 1 in 5 overall.

Older people

• People most at risk locally are: - men

LAA NI 137 • Large rise by 2025 in over 65 population, especially in those over 85.

• Those with heart disease or stroke had the worst health functioning by far.

• 1 in 10 had a physical disability aged 65-74 years rising to 1 in 5 aged over 75.

• Levels of being at least overweight rose to 3 in 4 people.

• Life expectancy and ‘healthy life expectancy’ at 65 is increasing but significant gaps between localities and between men and women.

• Too many still smoked, 1 in 8, and were happy to do so.

• Older people have worse health functioning than people under 65, but there are also big differences between localities – and gaps widened, especially for Dewsbury.

• Older people much more likely to suffer from all the major long term conditions: - over half had pain, including back pain, limiting them - increasing: diabetes has risen by 30% and is linked to higher rates of being overweight or obese • Most likely to be sedentary, but least likely to smoke or drink too much.

12 NHS Kirklees and Kirklees Council

- those on low income

• 1 in 3 did no physical activity and this is getting worse!

Dewsbury and Batley had the highest levels, as CVD is linked especially to smoking and low income.

Depression and / or anxiety • Affected 1 in 5, as in 2005.

• Had second worst impact on health functioning, after CVD, worse than 2005.

• Highest in Dewsbury and both Huddersfield localities.

• Also affected more of those with CVD, pain and backache.

• More still working than in 2005, though more have low incomes or receive a benefit.

• More likely to smoke, 1 in 3, and 3 times more likely to feel isolated.

Pain including backache

LAA NI 124 • Most common condition, affected 1 in 3 overall and 1 in 2 of older people. Big impact on health functioning, especially physical.

• Similar across all localities – but linked to low income.

Cancers: breast, prostate, lung, bowel, cervix Breast • Most common cancer overall, slight local drop and below national rate.

• Survival rates improving dramatically, 81% at 5 years.

Prostate

• 6 times more likely to feel isolated.

• Most common cancer for men but not increasing locally.

• 9 times more likely to be permanently sick or disabled.

• Survival rate improving to 76% at 5 years.

• 3 in 4 were at least overweight.

Lung

• 1 in 3 had sleep disrupted by pain, a sign of severity.

• 90% caused by tobacco.

• The care and prevention of pain is very variable, and also needs a fundamental redesign.

• Rates in men dropping but increasing in women.

Obesity and overweight LAA NI 124 • Huge problem and growing. Being overweight or obese is now ‘normal’ i.e. over half of local adults.

• Affects all localities – best 15% obese, worst 20%, Spen, Batley and Dewsbury.

• Obese people 4 times more likely to be diabetic, as diet is common cause.

• People with pain, diabetes, CVD much more likely to be obese i.e. 3 in 4.

• More likely to be physically inactive

• Locally more than half of new cases are women, especially aged under 65, much higher than nationally. Linked to smoking rates in women.

• Low survival rate due to late presentation, 6.5% at 5 years, so biggest killer of cancers.

Bowel • Slight drop locally.

• Survival rates improving dramatically to 49% at 5 years.

• Second highest killer after lung of all cancers.

• Those of Black origin were twice as likely to be obese.

Cervical

• People don’t recognise their own weight problem and its impact on their health.

• Survival rate now 65% at 5 years.

• Childhood obesity strongly linked with parental obesity.

Diabetes

LAA NI 124

• Increasing locally.

• Increases with age.

• People most at risk locally: - men - South Asian origin, especially under 65.

• People with diabetes are more likely to: - do no physical activity - be overweight or obese, i.e. 3 in 4 - have heart disease or a stroke (4 times more) - have visual impairment.

Physical activity and healthy diet are crucial for this group, in maintaining a healthy weight and good diabetic control, so reducing its consequences on health, short and longer term.

• New cases reduced to 2% of all cancers in women.

• Impact lessened due to earlier detection by the screening programme.

Dementia

LAA NI 124 • Increase of 50% by 2025 as affects 1 in 6 of those aged over 80, an increasing group.

• Often coexisting with depression, so diagnosis can be delayed or inaccurate.

• Can partly be prevented as vascular cause is linked to unhealthy behaviours.

Communicable disease • Hepatitis B and C are increasing, probably due to screening, which helps early diagnosis.

• TB continues to be high in certain localities, especially in those of Pakistani origin.

• Immunisation continues to have high coverage. MMR should be higher to protect everyone.

• Health Care Associated Infections: MRSA has reduced especially in South Kirklees. C. Difficile remained low.

Summary of issues for the people of Kirklees 13

Asthma

LAA NI 124 • 1 in 5 of people with asthma smoked, similar to overall.

• More older people with asthma tended to be at least overweight and did no activity at all.

• Housing felt inadequate due to poor health by 1 in 4.

• 1 in 4 woken by wheezing, at night, a sign of poor control.

Otherwise people with asthma were little different to the overall population.

Smoking

LAA 123, local • Improving but still too high at 1 in 5 adults, rising to 1 in 4 in Dewsbury, 1 in 3 of those aged 18-24 and 23% of women of child bearing age.

• Strong link to low income, and often used to cope with stress.

• Too high in smoking related conditions, 1 in 8, i.e. asthma, CVD, diabetes.

• 1 in 3 in those with mental ill health, rising to 2 in 5 of those who felt isolated.

• High rates of mothers smoking at birth (non South Asian) and wide variation across localities, 24% to 7%, and dropped markedly in Dewsbury and Batley.

• Drinking and smoking perceived as a ‘working class right’.

Physical activity

LAA NI 8, local • Not enough adults doing recommended levels, 28%, but more participating in sport and active recreation than before, 23%.

• Too many people doing no activity at all, 1 in 8 and rising. Especially people who are already disabled, obese or living with long term conditions especially pain, CVD and obesity.

• Most people want to be more active, but only 1 in 10 of those who never do anything.

• People feel walking is a key way of incorporating activity into daily life. This is a crucial form of free transport.

Alcohol

LAA NI 140, local • High levels drank over sensible limits, 1 in 3 men, 1 in 4 women, very slightly better than before. More White people, those aged 18-24, rose to half of Mirfield men, also linked to higher income.

• Binge drinking high especially in those aged 18-24, 2 in 3 of men vs. 1 in 2 of women. Overall bingeing much worse than nationally. Female students drank more than male, for the first time.

• People not concerned about their own level of drinking (especially women), very few concerned and plan to reduce (11% men, 7% women).

• Guidelines not seen as credible.

• Men – smoking helps relax, de-stress, socialise in groups.

• Self regulation based on short term risk e.g. hangover.

• Women – smoking offers ‘me time’ and helps leave worries behind.

• Women tend to drink at home, men at home and out of the home.

Remains a major concern, as smoking causes lung cancer which is higher in local women. Smoking is linked to infant deaths and many long term conditions.

• Alcohol viewed as way to de-stress and reward for getting through the day.

Food • Nationally low rates of 5 fruits and vegetables a day – local data probably unreliable.

• Barriers: lack of cooking skills and perceived high cost of healthy food.

• Low uptake of Healthy Start – low awareness of nutrients available.

• Breastfeeding – increasing starting, 71%. Unreliable figures for continuation.

• Women of child bearing age remain key group for concern, as are key shapers of family behaviours.

As our diet has become less healthy, so the impact on individual health and environment has risen, i.e. food miles.

14 NHS Kirklees and Kirklees Council

• Adults see bingeing as problem amongst younger people and not themselves.

• Passive drinking effects are large, i.e. the impact of excess drinking on others.

Drug misuse

LAA NI 40, local • Small numbers of dependent (2,800 heroin/crack cocaine) including injecting (1,015) drug users.

• Local people (esp. in certain neighbourhoods) see drug use as a big problem and linked to crime.

• Increasing rates of people in treatment and finishing it, 2055 individuals.

Sexual health

Accidents

• Sexually Transmitted Infections rising locally and nationally.

• Home most common site.

• High rates of gonorrhoea and chlamydia equate to high rates of risky sexual behaviour.

• Low levels of Road Traffic Accidents.

• HIV new cases low and stable, and more people surviving longer. Main route of transmission is sex between men and women, partly a result of migration from high risk countries.

Deprivation

Social and community networks LAA NI, 26, 17, 20, local • Most felt they belonged to their neighbourhood, rising with increasing age.

• Most people, 2 in 3, believed that people from different backgrounds get along together locally, but there was a clear north/south divide with people in north Kirklees much less likely to believe this. Again increased with age.

• 3 in 4 people didn’t think anti-social behaviour was a problem in their area. Those aged 18-24 or from BME communities were twice as likely to think it was than older people.

• 1 in 4 people volunteered regularly, those with poor health were least likely to.

• 1 in 3 older people, disabled and carers find it difficult to access groups which provide support.

Victims of crime were the most likely to find it difficult, especially in Dewsbury & Mirfield.

• Feeling lonely or isolated was highest in those aged 18-24 and decreased with age. Despite it being much higher in those with physical dependency needs, having pain or not being in work.

Housing and neighbourhood • 1 in 4 felt their home was inadequate, especially social or private rented, 1 in 3.

• Private rented more likely to cite main reasons – badly in need of repair, expensive to heat, too small, damp, too expensive.

• Dewsbury and Huddersfield South worst.

• 1 in 3 children lived in inadequate housing.

• 1 in 8 of most vulnerable living in fuel poverty (NB very narrow definition).

LAA NI 187 • Average house cost 4 times average salary.

• Homelessness almost exclusively affects younger adults, i.e. under 45.

• Most people like their local area (77%) especially older people. Lower in some areas and people who are in poor health much more likely to be dissatisfied.

LAA NI 124

• Attendances at A&E stable.

• 70,000 people were income deprived. Kirklees now 12th worst in England.

• 1 in 4 children living in poverty, especially Huddersfield and Dewsbury & Mirfield.

• 1 in 5 older people lived in poverty, especially Batley, Birstall & Birkenshaw as well as Dewsbury.

Employment and income LAA NI 150, 153, 173 • 20 times more people in work than unemployed – but unemployed figure increasing rapidly, and unemployment concentrated in Huddersfield, Dewsbury, Batley but high recent growth in the Valleys.

• Work and illness – mental ill health by far the biggest issue, causes half of all sickness absence and affects 1 in 5 working adults, 2 out of 5 Incapacity Benefit claims. Only other major issue is musculoskeletal problems (quarter of sickness absence, 1 in 5 Incapacity Benefit claims). 1 in 4 of working adults had recurrent backache or pain problems.

• People not in work are those most likely to suffer from anxiety and depression, feel lonely or isolated, have a disability or long term condition.

• Ill health is a major cause of worklessness and claiming benefits – 17,500 claiming Incapacity Benefit but slowly declining, but most (over 10,000 people) on it over 5 years. 1 in 10 of all working age adults had an out of work benefit.

• Low average household income and significant numbers of vulnerable people live in poverty. Low income is also linked to poor health i.e. having a disability or long term condition, smoking and physical inactivity.

Climate change

LAA NI 186, 187, 188 • Local effects; flooding, heat waves, snow and cold weather.

• Impacts on health, especially amongst vulnerable groups i.e. older people, people with long term conditions and infants.

• Solutions to climate change can contribute immediately to health and well-being: - increase in affordable warmth - reducing personal car use reduces accidents and pollution - increase in public transport to be reliable and affordable.

Summary of issues for the people of Kirklees 15

This report is available from www.kirklees.nhs.uk Search for ‘JSNA’

Kirklees Council Oldgate House 2 Oldgate Huddersfield HD1 6QW

NHS Kirklees St Luke’s House Blackmoorfoot Road Crosland Moor Huddersfield HD4 5RH

Tel: 01484 221000 www.kirklees.gov.uk

Tel: 01484 466000 www.kirklees.nhs.uk

Merran McRae Director for Adults and Communities

16 NHS Kirklees and Kirklees Council

Dr Judith Hooper Director of Public Health

Alison O’Sullivan Director for Children and Young People